This page provides clinical guidance on tetanus-prone wound management.
About tetanus-prone wound management
Tetanus is caused by a toxin released from Clostridium tetani, a spore-forming Gram-positive bacillus. Tetanus spores or bacilli can easily be introduced through injuries, even when the injury is trivial.
The following information about tetanus-prone wound management comes from 3D Regional HealthPathways, accessed January 2020:
- Decide whether wounds or injuries are clean or dirty.
• Clean – If minor, uncontaminated, non-penetrating injury, with negligible tissue damage, and less than 6 hours old.
• Dirty – If any of the following:
· Wound may be infected or contaminated eg, with soil, dust, horse manure, or a re-implanted avulsed tooth.
· Penetrating injury eg, bite wounds, compound fractures, wounds containing foreign bodies.
· Wound is more than 6 hours old.
· Tissue damage eg, crush injuries, avulsions, burns.
- Check tetanus immunisation history for completed primary course and date of last booster. If the patient is a child, check their vaccination status on the National Immunisation Register (NIR).
- Cleanse the wound thoroughly – irrigate the wound and debride any contaminated or non-viable tissue (necrotic tissue or slough).
- If the tetanus primary course is incomplete, provide tetanus vaccination. If the wound is dirty, also give tetanus immunoglobulin (TIG).
- If the tetanus primary course is complete, give tetanus vaccination if the wound is:
• clean but more than 10 years since the last dose or booster.
• dirty and more than 5 years since the last dose or booster.
Guidelines for the management of tetanus-prone wounds The Immunisation Advisory Centre, NZ
Spacing of Tdap after a Td vaccine The Immunisation Advisory Centre, NZ
Tetanus Immunoglobulin-VF (for intramuscular use) data sheet Medsafe, NZ
Tetanus Immunisation Handbook, NZ, 2017
- Tetanus-prone wound management 3D Regional HealthPathways, NZ, 2020